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Thursday, November 22, 2012

Staying Abreast

This year marks the fiftieth anniversary of the world's first silicon breast augmentation.

For almost a hundred years doctors, and patients, had been experimenting with various ways to change the size and shape of breasts. The first recorded case of a breast implant in the literature was undertaken by a German surgeon named Vincenz Czerny, who transplanted a benign fat tumour (known as a lipoma) to reduce asymmetry after removing a tumour from a woman's breast. Since that time various methods of using the patient's own tissue have been tried, mainly at the time of surgery to effect a reconstruction.

From the 19th century onwards there are records of various substances being implanted into the breasts in order to change the shape. However it is likely that this practice has been going on for many centuries, given the nature of human beings. Substances implanted included ivory, ground rubber, ox cartilage, sponges and glass balls. Although it sounds horrific sponge implants were actually reasonably common in the 1960s, although they led to hard, painful breasts.

Following the second world war a trade developed in many places, mostly by unlicensed practitioners, to enhance breasts with injectable liquids. Parrafin was occasionally used, with disastrous results including abcesses and death. However the most common form of injectable was silicon. This was particularly so amongst Japanese women trying to live up to a Western ideal. As much as two litres could be injected at one time.

Unfortunately, much of the time the silicon was mixed with various other substances, with things such as shellac, beeswax, peanut oil and glaziers putty (!). Outcomes with anything other than medical grade silicon were poor and included many deaths. Medical grade silicon as an injectable was briefly licensed by the FDA in America for research in 1965. However, even with medical grade silicon the complication rate was about 1%, with complications ranging from pain to severe irritation of the lungs to death. The cosmetic result from injectable silicon was also questionable, as breasts tended to harden and in extreme cases mastectomy was the only solution (if death from gangrene hadn't already occurred).

In 1961, Thomas Cronin and Frank Gerow thought they had a solution. Silicone had been used as an implantable in patients since 1950, mainly in stenting work in kidneys. The two plastic surgeons hit apon the idea of enclosing the injectable silicon in a bag, reportedly an idea that came to Gerow after he saw the new-fangled way of storing blood for transfusions.

They created a prototype - and implanted it initially into a dog. It stayed in for several weeks until she started chewing on her stiches and they had to remove it. Because she didn't seem to suffer any ill effects the surgeons decided to move onto human trials.

In 1962 a Texan woman named Timmie-Jean Lindsey presented to a charity hospital requesting removal of a tattoo on her breasts. The tattoo, of roses and vines, had been placed on her skin during a now ended relationship.

Cronin and Gerow sensed an opportunity and suggested implants. This surprised Lindseyas she reportedly had never had a problem with her breasts. She had more concerns about how her ears stuck out. The three stuck a deal. Lindsey would get implants and they would do her ears at the same time.

The ethics behind this initial operation were dubious to say the least, with little in the way of informed consent and a whiff of coercion in patient selection.

Nonetheless Lindsey went from a B cup to a C cup. And a revolution began.

Silicone implants have not been without controversy. In the 1990s concern was raised that leakage or rupture of the implants could potential lead to connective tissue and autoimmune disease. They were temporarily banned for a while, although the number of breast augmentation surgeries did not decrease. Patients simply started having surgery with the saline filled implant that was invented in 1964. The concerns about silicon implants have since been proven to be unfounded, and there use has subsequently increased in popularity again.

Controversy has recently occurred again with the PIP silicon implants, which allegedly have an increased risk of rupture and caused the recent deaths of some French women from cancer. Whether or not this is related to the implant is still yet to be determined.

It is estimated that somewhere between five and ten million women world wide have undergone breast augmentation surgery. Some of this number are cancer patients undergoing reconstructions and some are transexual patients. The vast majority, however, are undergoing the procedure for purely cosmetic purposes.

Timmy-Jean Lindsey herself has at various times expressed differing feelings about the implants she never really wanted in the first place. She reported issues of pain and fatigue that she attributes to the silicon, but has never joined a class-action suit, despite being urged to do so. She is most recently quoted as saying:

"You would think they would stay real perky, but no - they are just like
a regular breasts, they begin to sag over the years. That surprised me.
I figured they'd just stay where they were."